Issue 9

Breast left alone

By Helen Gray

I am going to start this article on a personal note, not something that I would usually do, but I want everyone that reads this article to first see that this is in no way an ‘anti-breastfeeding’ piece and secondly to see that it is my ability to choose, access to resources and relatively privileged life which give me the opportunity to choose how I feed my babies. It’s this choice that we need to protect and explore.

As I write I have my two beautiful children with me, both breastfed for over a year. I have been fortunate enough that despite having a few ‘teething problems’ (sorry about the pun), the usual thrush, mastitis and cracked nipples, I was able to persevere and have had beautiful breastfeeding relationships with both of my children. In order to do this I have been incredibly fortunate with healthy, full term babies, a supportive home life, a wonderful partner, access to excellent and free healthcare and employers who have gone way beyond the call of duty by frequently allowing me to breastfeed my children in the workplace. I also had an electric pump, a fridge, sterilising equipment, powdered formula milk and an array of different bottles at my disposal for when I wasn’t able to actually breastfeed for my first child and the second, well, she was so happy and easy at the breast that she consistently refused to accept a bottle of anything from anyone. It has been idyllic and I am so happy that I was able to do as I chose and breastfeed without interference.

However, what is important here is that I am in an extremely privileged position and I was able to choose what I did with my breasts. I have absolutely no opinion on what any other woman chooses to do with her breasts and I actually will go as far to say that formula could be, and frequently is, a superb second choice for women who cannot or do not wish to breastfeed their babies for whatever reason. To breastfeed or not to breastfeed should be a choice for every woman the world over. That this is not the case is a tragedy in its own right, that there are movements that wish to legislate breasts and dictate the way in which women use them is inconceivable and yet sadly a very modern reality.

Anyone who has any interest in this field will most probably be aware that a new law has recently been passed in the United Arab Emirates to force women to breastfeed or face penalties. This draconian law would force mothers to breastfeed making “breastfeeding a duty and not an option for able mothers.” Why is it that breastfeeding is so very essential to the government that it must be enforced to the point that women are no longer allowed the freedom to decide what is best for them and their babies? According to Dr. Al Ari, a doctor serving on the national council's health, labour and social affairs committee, “Breastfeeding also has benefits for the mother, as well as the child. This has been known for years.” I suspect that Dr. Al Ari is referring to the constant bombardment of information telling women that “breast is best”, showing links between breastfeeding and decreased obesity, diabetes, asthma, ear infection, respiratory infection, higher IQ, lower ADHD and so on. These health benefits may well exist, but as we’ll see later on, they’re far from proven and even if given the current data, we all chose to accept their existence as truth, the benefits could still pale into insignificance when we actually think deeply about the fact that we are legislating on people’s bodies. This prescriptivism over what a woman should do with her breasts veers creepily into a Handmaid’s Tale dystopian view of women’s bodies as vessels for children.

I was personally interested to see whether these views had arisen because of the new studies into the powers of breast milk. Were we viewing women’s bodies entirely objectively using brand new scientific methods that can read the magical properties and translate them into verifiable scientific figures or are we re-hashing misogynistic ideas from our collective past and using science as our cover? Unfortunately, I didn’t need to look too far to find Rosseau’s writings on the ‘first duty’ of a mother:

“Do you want to bring everyone back to his first duties? Begin with mothers. You will be surprised by the changes you will produce. Everything follows successively from the first depravity […] But let mothers design to nurse their children and morals will reform themselves, nature’s sentiments will be awakened in every heart and the nation will be repopulated. This first point and this alone will bring everyone back together.”

This passage is from the 1700s and ‘the first depravity’ for Rosseau is wet nursing. Not to be hyperbolic but I think we can happily replace wet nursing with formula feeding and see that we’re pretty much in the same place with the UAE law. On this score then, the law is just a re-hashing of misogynistic views on women’s bodies under the new banner of science.

Given that we’re seeing science being used in the drive to promote breastfeeding as an absolute essential in child health, can we then assume that science was unanimous and resounding in its findings on the benefits of breast milk? Joan Wolf disagrees and her book Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood goes into far more detail that I ever could here. Essentially, the science is not unanimous, isn’t always replicable, and does not show breast milk to be the panacea to cure all ailments. She goes as far as to state that ‘science does not demonstrate compellingly that breast milk or breastfeeding is responsible’ for the improved health outcomes of breastfed babies. A 2006 longitudinal study failed to find any affect of breastfeeding on long term IQ, The famous PROBIT study found evidence of a lower rate of GI infections and eczema in the first year of life, but no benefits elsewhere. A recent sibling study has echoed this sentiment by finding that in shorthand, when you remove socio-economic, ethnic and whatever other confounders, breast may not always be best:

“Results from between-family comparisons suggest that both breastfeeding status and duration are associated with beneficial long-term child outcomes. This trend was evident for 10 out of the 11 outcomes examined here. When we more fully account for unobserved heterogeneity between children who are breastfed and those who are not, we are forced to reconsider the notion that breastfeeding unequivocally results in improved childhood health and wellbeing. In fact, our findings provide preliminary evidence to the contrary. When comparing results from between- to within-family estimates, coefficients for 10 of the 11 outcomes are substantially attenuated toward zero and none reach statistical significance (p < 0.05). Moreover, the signs of some of the regression coefficients actually change direction suggesting that, for some outcomes, breastfed children may actually be worse off than children who were not breastfed.”

Certainly there are benefits to breastfeeding, but as Dr. Amy Teuter has repeatedly argued on her blog The Skeptical Ob, “although the benefits of breastfeeding are real, they are small and restricted to relatively unimportant risks like colds or episodes of diarrheal illness during the first year of life.” This quote takes a pretty dim view of the benefits of breast milk and perhaps there is more that we do not yet know; I don’t want to get into the nitty gritty of scientific research as it would be all too easy to do. The sibling study still can’t take into account the underlying reasons why one sibling was breast fed and the other not, and Joan Wolf has been criticised for her background in social science as opposed to medical or epidemiological science, both valid and tip of the iceberg responses. There will obviously always be problems with any scientific studies and nothing should be taken as is.

My point here is that whilst there is any question over any health benefit to anyone, on anything, should we be legislating? More, when that health benefit restricts bodily autonomy, should we rush to immediately legislate? When that law could force women out of the workplace, place an uneven burden of responsibility upon women for child nutrition or force them to go through what is for some women a painless and joyless process, should we really be legislating?

This leads to the final and most important question: will legislation help women? From all that can be seen from this new law, no. There is no attempt to look at any of the reasons that women do not breastfeed or do not want to breastfeed. There exists a fabulous online voice of reason in the form of Susanne Barston, AKA The Fearless Formula Feeder. Having struggled with PPD and a baby who had severe allergies to breast milk she found that formula was the best option for her and her family. On doing so she also uncovered a mine of judgement, bullying and harassment for formula feeding women, as well as a dearth of any sensible and non-judgemental information on bottle feeding. Compare Dr Sears’ advice on bottle feeding here with his advice on breastfeeding here. Susanne, somewhat fearlessly, set up a blog and Facebook page dedicated to helping women to overcome the guilt and shame they felt at not being able to live up to their breastfeeding wishes, and giving them a platform to share their experiences.

Asked to comment on the ideas discussed in this article, Barston had this to say: "In a time where breastfeeding is valued so heavily that laws are being implemented to ensure that women do it, logic says that most women have a significant emotional (and in the case of UAE, legal) motivation to attempt nursing their young. This is not something like eating your vegetables, or using an electric car, or switching to cloth diapers – breastfeeding, we are told, is the 'most important' thing a mother can do for her infant, the thing that will ensure his health, cement her social and financial prospects. The exhortations go far beyond simple health arguments, mixing a mother’s ability to lactate with her morality and worth. With ambivalent research which gives us little concrete proof that this near-magical view of breastfeeding is valid, we must weigh the potential toll breastfeeding pressure can take on women, with the potential advantage nursing may confer to infants. Much of the research we do have that suggest benefits to breastfeeding was presumably done in situations where women were breastfeeding by their own free will – how will it affect, say, the bonding benefits when a mother approaches each feeding with dread, scared that she won’t be able to produce enough to satiate her infant, or with anger, knowing the emotional or physical pain that will come when her baby latches on? Forcing women to breastfeed is not the answer. You cannot force breasts to work when they don’t; you cannot force a woman to quit her job when she is the sole breadwinner for her family; you cannot force a baby with a bad latch to nurse appropriately. What you can do is enforce legislation that ensures adequate pumping breaks for working mothers, forbids predatory formula marketing, and allows for 24-hour free lactation assistance for the early postpartum period. Instead, the UAE has thrown the responsibility onto its women, stripping them of yet another right to bodily autonomy."

These experiences amount to a long list of the reasons that women chose not to or couldn’t breastfeed and guess what, none of those reasons were that they were swayed by formula marketing, fear of ‘losing her man’ or preference for her breasts as sexual objects as suggested in Palmer’s The Politics of Breastfeeding: When Breasts are Bad for Business. Instead we see a heart-wrenching litany of struggles from recurring infection, babies who were unable to thrive on breast milk, serious milk allergies, pre-term and unwell babies, survivors of sexual abuse who are forced to re-live their experiences by the act of breastfeeding, post-partum depression and so on. Advocates of the UAE law would claim that for women who truly can’t breastfeed, there would be exemptions. Who gets to decide and what these exemptions are is woefully under-explored and cannot assuage the fact that we are still left with a third party having the final say on what a woman does with her own body.

I cannot understand, and please forgive the whiny tone, is: Why are we not leaping in to support these women? To help them through their decision, and it IS a choice, over whether or not they would like to breastfeed? Where there are women who lacked the resources and access to help to breastfeed, why are we not up in arms? Where there are women who did not want to access resources and medical help, why are we judging them for making a choice over their own bodies? If formula is so terribly sub-standard, why are we not addressing this?

Legislating and advocating punishment for women who cannot or do not wish to breastfeed does nothing to address the underlying problems many women face or the judgement that is so prevalent within the breastfeeding world. Legislating is not supported by science; in fact, I fear that science is simply being used as a new vehicle for misogyny. Legislation does nothing to preserve the beauty of a woman’s choice to breastfeed, it simply undermines a woman’s autonomy.

To end on a personal note. My youngest baby is turning one this week and I have no intention of ending our breastfeeding relationship any time soon. I love breastfeeding. It has been a beautiful experience for me and I would fight tooth and nail for everybody to have that door opened for them. I will also fight tooth and nail for any person who did not want to breastfeed and felt judged and maligned for choosing not to. Women do not need legislation, they do not need condescending literature which casts them as poor ignorant souls who can’t withstand formula marketing. Women need not the threat of punishment and grubby re-workings of three-hundred–year-old views on women’s ‘first duties,’ but support, space and the respect that they are due in their journey into motherhood, a journey where they are perfectly entitled to make decisions on their own bodies.

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